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Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis

  • Hepatobiliary Tumors
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Abstract

Background

Targeted therapy or chemotherapy is suggested as standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 1–2 according to the Barcelona Clinic Liver Cancer (BCLC) system. The underlying rationales have not been fully studied.

Methods

This study enrolled 2,620 HCC patients. One-to-one matched pairs between HCC patients receiving aggressive anti-HCC treatments (resection, transplantation, ablation, and transarterial chemoembolization) and those receiving targeted therapy or chemotherapy or best supportive care were generated by using the propensity score with a matching model. Survival analysis was performed with the Kaplan–Meier method and the log-rank test. Mortality risk was calculated with the Cox proportional hazards model.

Results

Of 793 patients with PS 1–2, 64 % received aggressive anti-HCC treatments against the suggestion of the BCLC system. The patients receiving aggressive anti-HCC treatments had significantly milder cirrhosis, a smaller tumor burden, and better long-term survival than the patients undergoing targeted therapy or chemotherapy or best supportive care (all p < 0.05). With the use of propensity scores, 166 pairs of matched HCC patients with PS 1–2 were selected from different treatment groups. After matching, patients were comparable in age, gender, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all p > 0.05) at baseline. In the propensity score model, patients with PS 1–2 undergoing aggressive anti-HCC treatments had significantly better long-term survival (p < 0.0001). The adjusted hazard ratio of the choice for targeted therapy or chemotherapy or best supportive care to the choice for aggressive anti-HCC treatments was 2.028 (p < 0.0001).

Conclusions

According to the findings, HCC patients with PS 1–2 should consider aggressive anticancer treatments if no contraindication is noted. Adjustment of the BCLC treatment allocation is needed to enhance its prognostic accuracy.

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Acknowledgment

This study was supported by Grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007) in Taiwan, from the Taipei Veterans General Hospital (V103C-008) in Taipei, Taiwan, and from the Ministry of Education, Aiming for the Top University Plan (103AC-P618) in Taiwan.

Disclosure

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Author information

Authors and Affiliations

  1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Chia-Yang Hsu MD, MPH, Po-Hong Liu MD, Yun-Hsuan Lee MD, Cheng-Yuan Hsia MD, Yi-You Chiou MD & Teh-Ia Huo MD

  2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yi-Hsiang Huang MD, PhD

  3. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Teh-Ia Huo MD

  4. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chia-Yang Hsu MD, MPH, Po-Hong Liu MD, Yi-Hsiang Huang MD, PhD & Teh-Ia Huo MD

  5. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Yuan Hsia MD

  6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-You Chiou MD

  7. Department of Medicine, Yuanshan Branch of Taipei Veterans General Hospital, I-Lan, Taiwan

    Yun-Hsuan Lee MD

  8. Queen of Angels Hospice, Arcadia, CA, USA

    Ya-Ju Tsai MSN, ACNP-BC

  9. Department of Pathology, University of Toronto, Toronto, Canada

    Teddy S. Nagaria MD, PhD

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  1. Chia-Yang Hsu MD, MPH
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  2. Po-Hong Liu MD
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  4. Cheng-Yuan Hsia MD
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  5. Yi-Hsiang Huang MD, PhD
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  8. Teddy S. Nagaria MD, PhD
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  9. Teh-Ia Huo MD
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Corresponding author

Correspondence to Teh-Ia Huo MD.

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Hsu, CY., Liu, PH., Lee, YH. et al. Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis. Ann Surg Oncol 22, 1324–1331 (2015). https://doi.org/10.1245/s10434-014-4151-2

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  • DOI: https://doi.org/10.1245/s10434-014-4151-2

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